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Richard M. Scheffler, Daniel R. Arnold, and Christopher M. Whaley, Consolidation Trends in Californias Health Care System: Impacts on ACA Premiums and Outpatient Visit Prices, Health Affairs 37, no. The 2019 SAHIE report describes demographic and economic differences and trends in health insurance coverage in states and counties. We are happy to help. Share sensitive information only on official, secure websites. The Uninsured and the ACA: A Primer - Key Facts about Health - KFF California's decision to expand Medi-Cal to cover most low-income adults without children or a qualifying disability was responsible for much of these gains. For the ASPE report on the uninsured and ACA-related enrollment, please visit https://aspe.hhs.gov/reports/health-coverage-changes-2021-update. Inadequate insurance coverage leaves people exposed to high health care costs, and these expenses can quickly turn into medical debt. 22. "With a record-breaking total of over 35 million people who now have health coverage, thanks to the Affordable Care Act, America's uninsured rate is nearing an all-time low," said Health and Human Services Secretary Xavier Becerra. The report, which analyzes data from the National Health Interview Survey and American Community Survey, shows the dramatic impact of Biden-Harris Administrations efforts to increase health care access and lower costs for Americas families through the American Rescue Plans enhanced Marketplace subsidies, the continuous enrollment provision in Medicaid, several recent state Medicaid expansions, and substantial enrollment outreach by the Administration in 2021 and 2022. A .gov website belongs to an official government organization in the United States. Some (4.1 million, or 15%) are ineligible due to their immigration status or their states decision not to expand Medicaid. Washington, D.C. 20201 Gap Closed: ACA's Impact on Asian Americans' Health Coverage More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans. 39 million Obamacare and Medicare beneficiaries have free access to a series of preventive medical services. In 2018, 61 percent of people who reported a coverage gap said it has lasted for six months or less, compared to 31 percent who said they had been uninsured for a year or longer. States that have expanded Medicaid have lower uninsured rates than non-expansion states. Lowered the share of adults with disabilities under age 65 who were uninsured for a full year by nearly half. Toll Free Call Center: 1-877-696-6775, Note: All HHS press releases, fact sheets and other news materials are available at, Content created by Assistant Secretary for Public Affairs (ASPA), New HHS Report Highlights 40 Percent Decline in Uninsured Rate Among Black Americans Since Implementation of the Affordable Care Act, HHS Office for Civil Rights Settles Complaint with Florida Health Center that Failed to Provide Effective Communication for a Patients Caregiver, HHS Releases Proposal to Expand Health Care for DACA Recipients, HHS Finalizes Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024. Toll Free Call Center: 1-877-696-6775, Note: All HHS press releases, fact sheets and other news materials are available at, Content created by Assistant Secretary for Public Affairs (ASPA), New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage, https://aspe.hhs.gov/reports/health-coverage-changes-2021-update, HHS Office for Civil Rights Settles Complaint with Florida Health Center that Failed to Provide Effective Communication for a Patients Caregiver, HHS Releases Proposal to Expand Health Care for DACA Recipients, HHS Finalizes Policies to Make Coverage More Accessible and Expand Behavioral Health Care Access for Millions of Americans in 2024. The deductible component provides an indicator of the financial protection the plan offers and the risk of incurring costs before someone gets health care. Previously eligible parents in nonexpansion states also saw gains in coverage overall, with an 8.4 percentage . Ongoing efforts to further alter the ACA or to make receipt of Medicaid more restrictive may further erode coverage gains seen under the ACA. If the remaining twelve non-expansion states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, Wyoming) were to expand Medicaid, an estimated 957,000 Black Americans without insurance coverage would become eligible for Medicaid coverage. We can't leave them behind.". 2. Approximately 5.4 percent of adults 18-64 reported having Marketplace coverage in early 2022 compared to 4.4 percent in 2020, reflecting approximately 2 million additional adult Marketplace enrollees roughly half of the 4 million adults who gained health coverage over this period. Share sensitive information only on official, secure websites. Starting in 2021, the Biden-Harris Administration implemented legislative and administrative actions to expand affordable coverage options. ACA Marketplaces and the Medicaid expansion and the subsequent reductions in statelevel uninsured rates since the ACA was implemented in 2014. PDF Hp-2021-02 Trends in The U.s. Uninsured Population, 2010-2020 - Aspe Findings from the Commonwealth Fund Affordable Care Act Tracking Survey, MarchJune 2017 (Commonwealth Fund, Dec. 2017). For example, according to the American Community Survey, the uninsured rate among adults age 19 to 64 in 2019 was lower in states that expanded (9.8 percent) than in those states that did not (18.4 percent). This is likely because the ACA requires insurers and employers to cover recommended preventive care and cancer screens without cost-sharing. Secure .gov websites use HTTPS 15. 19. The consequences can be severe, particularly when preventable conditions or chronic diseases go undetected. In 2010, 16 percent of all Americans were uninsured; by 2016, the uninsured rate hit an all-time low of 9 percent. The uninsured rate fell from 10.3% in 2020 to 8.9% in the third quarter of 2021 according to HHS data. The ACA made only minor changes to employer plans, and the erosion in cost protection has taken a bite out of the progress made in Americans health coverage since the laws enactment. In 2021, that translated to $17,130 for a single person and $35,245 for a family of four. Oklahoma and Missouri, which expanded Medicaid coverage in 2021, saw an enrollment increase of more than 276,300 and 146,600 individuals, respectively. An estimated 1 million Californians are uninsured and eligible for low-cost or no-cost coverage through Covered California . As we move forward, the Department of Health and Human Services will continue to do everything we can to protect, expand, and strengthen the programs that provide the quality, affordable health care Americans rely on and deserve. The uninsured rate among Black Americans that report Latino ethnicity is similar to the uninsured rate among non-Latino Black Americans. Explore census data with visualizations and view tutorials. A combination of landline and cellular phone random-digit dial samples was used to reach people. The number of uninsured people and the share of the nonelderly population that was uninsured rose from 44.2 million (17.1%) to 46.5 million (17.8%) between 2008 and 2010 as the country faced an economic recession (Figure 2). whether high out-of-pocket health care costs and deductibles are causing them to be underinsured, despite having continuous coverage throughout the year. June 5, 2021 HP-2021-13 Health Coverage Under the Affordable Care Act: Enrollment Trends and State Estimates Based on enrollment data from late 2020 and early 2021, approximately 31 million people were enrolled in Marketplace or Medicaid expansion coverage related to provisions of the Affordable Care Act (ACA), the highest total on record. The coverage gains achieved during Open Enrollment are just a first step CMS will continue to advance health equity by expanding coverage access through Medicaid and the Childrens Health Insurance Program, Medicare and the ACA Marketplaces.. Opens in a new window. But the improvement in uninsured rates has stalled. Share sensitive information only on official, secure websites. Christine Eibner, Sarah Nowak, and Jodi Liu, Hillary Clintons Health Care Reform Proposals: Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit (Commonwealth Fund, Sept. 2016). More people who have coverage are underinsured now than in 2010, with the greatest increase occurring among those in employer plans. We found that 26.8 percent of new mothers with Medicaid-covered prenatal care were uninsured before pregnancy, 21.9 percent became uninsured two to six months postpartum, and 34.5 percent were . The resulting weighted sample is representative of the approximately 193.9 million U.S. adults ages 19 to 64. Thats why the Biden-Harris Administration has worked tirelessly to expand access to health insurance and lower costs for Americas families through the American Rescue Plan and other actions. In states that expanded Medicaid eligibility, 9.2% of counties (151 of 1,647) had an estimated uninsured rate above 20% among working-age adults living at or below 138% of poverty, compared to 84.8% of counties (1,267 of 1,494) in states that didnt expand it. 11. Sara R. Collins, Consumers Shopping for Health Plans Are Left in the Dark by Trump Administration, To the Point (blog), Commonwealth Fund, July 19, 2018. Nearly four million additional people could benefit from this coverage if Medicaid is expanded in all states. Being underinsured, however, does not seem to reduce the likelihood of having a usual source of care or receiving timely preventive care or cancer screens provided a person has continuous coverage. No news release associated with this report. For many uninsured people, the costs of health insurance and medical care are weighed against equally essential needs, like housing, food, and transportation to work, and many uninsured adults report financial stress beyond health care.4 When uninsured people use health care, they may be charged for the full cost of that care (versus insurers, who negotiate discounts) and often face difficulty paying medical bills. Coverage gains were particularly large among low-income adults in states that expanded Medicaid. 200 Independence Avenue, S.W. 21. This data is critical for government programs, policies, and decision-making. The ACA also has helped stabilize health costs for many small businesses that provide . Five states with uninsured rates of 12% or more (Florida, Georgia, Oklahoma, Texas and Wyoming) had not expanded Medicaid eligibility. Figure 4: Change in Uninsured Rate Among the Nonelderly Population by Selected Characteristics and Expansion Status, 2016-2017, Many remain uninsured are eligible for ACA assistance, but about half are outside the reach of the ACA. While the safety net of public hospitals, community clinics and health centers, and local providers provides a crucial health care source for uninsured people, it does not close the access gap for the uninsured. All Rights Reserved. Our Scorecard ranks every states health care system based on how well it provides high-quality, accessible, and equitable health care. 16. Despite large gains in health coverage, some people continued to lack coverage, and the ACA remained the subject of political debate. Secure .gov websites use HTTPS How have health insurance coverage options and availability changed under the ACA? The Uninsured and the ACA: A Primer - Key Facts about Health - KFF Share sensitive information only on official, secure websites. The share of those who had been uninsured for six months or less climbed to 20 percent, nearly double the rate prior to the coverage expansions. The creation of the individual marketplaces and the expansion of Medicaid under the ACA has led to more small-business employers and their employees having health coverage than before the law was implemented. 28. Centers for Medicare and Medicaid Services, CMS Issues the Proposed Payment Notice for the 2020 Coverage Year, news release, Jan. 17, 2019. 3 However, colorectal, lung, and breast cancer remain the most prevalent cancers among the uninsured. The independent source for health policy research, polling, and news. Privacy Policy, Fewer Uninsured Americans and Shorter Coverage Gaps, But More Underinsured, International Health Care System Profiles, Read the report to see how your state ranks. 10. Changes in coverage and access : MACPAC About 20 million Americans have gained health insurance coverage since the ACA . The most important key figures provide you with a compact summary of the topic of "Obamacare" and take you straight to the corresponding statistics. For general media inquiries, please contactmedia@hhs.gov. U.S. How does lack of insurance affect access to care? PDF Health Coverage Under the Affordable Care Act: Enrollment Trends and Clicking on the following button will update the content below. Figure 2: Number of Uninsured and Uninsured Rate Among the Nonelderly Population, 2008-2017, Coverage gains through 2016 were largest among low-income people, people of color, and adultsgroups that had high uninsured rates prior to 2014and were particularly large in states that expanded Medicaid. Results show that among SEP enrollees reporting their race and ethnicity, the share of enrollees that were Black increased from 9 percent in 2019 to 15 percent in 2021. After the Affordable Care Act went into effect, the share of uninsured American adults fell. Two-thirds of the 1.7 million Covered California consumers are eligible for comprehensive health coverage for as little as $10 per month and others can get covered for no cost. The uninsured rate among low-income, non-elderly adults in expansion states was 17 percent in 2019, roughly half of its 35 percent in 2013. 9. The remainder of the uninsured either has an offer of coverage through an employer or has income above the limit for marketplace tax credits (Figure 5). The lack of continued improvement in overall access to care nationally reflects the fact that coverage gains have plateaued, and underinsured rates have climbed. . Douglas Conway Adults ages 19 to 34 had the highest uninsured rates of any age group in the United States, according to the 2019 American Community Survey (ACS). People in this age group had an average uninsured rate of 15.6% compared to 5.7% for those under 19, 11.3% for adults ages 35 to 64, and 0.8% for individuals 65 and older in 2019. Find your information in our database containing over 20,000 reports, highest spending on health as a percentage of GDP, 31 million individuals now benefit from ACA-related enrollment, numerous studies have reported the positive impact of Medicaid expansion, 19.2 thousand lives were saved from treatable conditions, those who are insured but effectively underinsured, 2.2 million people in these non-expansion states, adults living alone represent the highest share of those uninsured, protection against preexisting conditions, a rise in the percentage of uninsured after 2017, Introduction: high uninsured rates before ACA, Current picture: Medicaid expansion vs non-expansion states, Payment & delivery reform: Accountable Care Organizations. By 2013, the year before the major coverage provisions of the Affordable Care Act (ACA) went into effect, more than 44 million nonelderly individuals lacked coverage.1. Southern states that have not expanded Medicaid have some of the nations highest uninsured rates for all population groups, as well as large Black populations. Private health insurance in the United States, Get the best reports to understand your industry, Health Insurance Coverage in the United States: 2015. 10 Ways the ACA Has Improved Health Care in the Past Decade In this analysis, we use a measure of underinsurance that accounts for an insured adults reported out-of-pocket costs over the course of a year, not including insurance premiums, as well as his or her plan deductible. Uninsured Health Coverage Rates Decline in Majority of U.S. The data are weighted to the U.S. adult population by age, sex, race/ethnicity, education, household size, geographic region, population density, and household telephone use, using the U.S. Census Bureaus 2017 Annual Social and Economic Supplement. And I'm hopeful that with Congressional action we can continue the work to lower costs for more Americans by both extending the enhanced Affordable Care Act tax credits that have helped drive the uninsured rate to an all-time low and increasing the affordability of prescription drugs for Medicare beneficiaries -- reducing their cost sharing and allowing Medicare to negotiate a better deal on prescription drug prices.. Rachel Garfield , An official website of the United States government. When the major ACA coverage provisions went into effect in 2014, the number of uninsured and uninsured rate dropped dramatically and continued to fall through 2016 to 26.7 million (10.0%).. Coverage gains were driven by increases in Medicaid and non-group coverage that offset. Today, the U.S. Department of Health and Human Services, through the Office of the Secretary for Planning and Evaluation (ASPE), released a report showing new estimates for coverage related to the Affordable Care Act (ACA), concluding that the total enrollment for Medicaid expansion, Marketplace coverage, and the Basic Health Program in participating states has reached an all-time high of more than 35 million people as of early 2022. The Uninsured and the ACA: A Primer - Key Facts about Health - KFF 2018. The report also shows that there have been reductions in uninsurance rates in every state in the country since the law's coverage expansions took effect. Uninsured rates among adults ages 18-64 declined from 14.5 percent in late 2020 to 11.8 percent in early 2022. Non-Hispanic Whites had lower estimated uninsured rates than both Hispanics and non-Hispanic Blacks under age 65 in every state and the District of Columbia. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KFF | twitter.com/kff. The RDD landline portion of the survey achieved a 8.4 percent response rate and the RDD cellular phone component achieved a 5.2 percent response rate. pio@census.gov. In 2019, 33.6% (or 1,054) of U.S. counties had an estimated uninsured rate below 10%, down from 38.6% in 2016, 38.4% in 2017, and 37.7% a year earlier but up from 2013 when only 4.1% or 130 counties had uninsured rates under 10%. The Biden-Harris Administration also extended the deadline for the 2022 Open Enrollment Period, which ran from November 1, 2021, to January 15, 2022 in most states, to give people more time to sign up for health insurance. A lock (LockA locked padlock) or https:// means youve safely connected to the .gov website. These surveys were conducted by Princeton Survey Research Associates International using the same stratified sampling strategy that was used in 2018, except the 2001, 2003, and 2005 surveys did not include a cellular phone random-digit dial sample. Several factors may be contributing to high underinsured rates among adults in individual market plans and rising rates in employer plans: It is well documented that people who gained coverage under the ACAs expansions have better access to health care as a result.6 This has led to overall improvement in health care access, as indicated by multiple surveys.7 In 2014, the year the ACAs major coverage expansions went into effect, the share of adults in our survey who said that cost prevented them from getting health care that they needed, such as prescription medication, dropped significantly (Table 4). Receive the latest updates from the Secretary, Blogs, and News Releases. Health Care Reform in California - Public Policy Institute of California And among people with coverage all year, those who were underinsured reported cost-related delays in getting care at nearly double the rate of those who were not underinsured. One of the ACAs most notable provisions aimed at employers was the so-called employer mandate the requirement that large firms offer affordable coverage to full-time employees or pay penalties. Washington, D.C. 20201 In 2001, the survey was conducted from April 27 through July 29, 2001, and included 2,829 adults ages 19 to 64; in 2003, the survey was conducted from September 3, 2003, through January 4, 2004, and included 3,293 adults ages 19 to 64; in 2005, the survey was conducted from August 18, 2005, to January 5, 2006, among 3,352 adults ages 19 to 64; in 2010, the survey was conducted from July 14 to November 30, 2010, among 3,033 adults ages 19 to 64; in 2012, the survey was conducted from April 26 to August 19, 2012, among 3,393 adults ages 19 to 64; in 2014, the survey was conducted from July 22 to December 14, 2014, among 4,251 adults ages 19 to 64; and in 2016, the survey was conducted from July 12 to November 20, 2016, among 4,186 adults ages 19 to 64.